TAVI - Sapien 3 (Edwards): Difference between revisions
From Bay Area Structural Heart Wiki
No edit summary |
No edit summary |
||
(2 intermediate revisions by 2 users not shown) | |||
Line 22: | Line 22: | ||
*A extension line from anesthesia (Venous extension only if we are doing bipolar pacing) | *A extension line from anesthesia (Venous extension only if we are doing bipolar pacing) | ||
*5Fr AL1 diagnostic | *5Fr AL1 diagnostic | ||
*5Fr Ang Pigtail | *(2) 5Fr Ang Pigtail | ||
**'''Valve-in-valve: Mosaic needs pigtail, all others do not.''' | **'''Valve-in-valve: Mosaic needs pigtail, all others do not.''' | ||
*6Fr JL4/JR4 (when doing coronary angiography) | *6Fr JL4/JR4 (when doing coronary angiography) | ||
Line 144: | Line 144: | ||
* (2) Cordis 150J | * (2) Cordis 150J | ||
* Cordis 260J | * Cordis 260J | ||
* 2 Perclose | |||
* 2 Pigtails | * 2 Pigtails | ||
* Straight steel .035 wire (NO straight stiff glide) | * Straight steel .035 wire (NO straight stiff glide) | ||
* | * Amplatz ES for sheath advancement | ||
* Safari | * Safari | ||
* 5F Abbott Pacel Balloon Flow Directed Tip Pacing catheter for CS | * 5F Abbott Pacel Balloon Flow Directed Tip Pacing catheter for CS |
Latest revision as of 16:49, 1 November 2024
Transcatheter Aortic Valve Repair (Wikipedia)
Daniels
ACIST A1000V SYRINGE USED WITH 50/50 CONTRAST MIX
Equipment :
- 5Fr Micropunture Kit
- 6Fr x 10cm sheath
- 8Fr x 10 cm sheath
- (2) Cordis 150J
- Cordis 260J
- Safari Wire (DANIELS & SPIES)
- Amplatz Extra Stiff 1cm tip (GROVES)
- Terumo Stiff Straight Glidewire 0.035 x 150 cm
- .035 Standard Straight for Valve-in-Valve crossing, no need for glidewire.
- Acist hand control
- (3) Perclose
- A extension line from anesthesia (Venous extension only if we are doing bipolar pacing)
- 5Fr AL1 diagnostic
- (2) 5Fr Ang Pigtail
- Valve-in-valve: Mosaic needs pigtail, all others do not.
- 6Fr JL4/JR4 (when doing coronary angiography)
- Exofin topical adhesive
- NuKnit for closure
Unipolar Transvenous pacing supplies (Daniels preference)
- Alligator Clip Remington Pacing Cables
- TZ Medical Defibrillation Pads - Found in EP pyxis in labs. Large pad utilized as a grounding pad on the patients chest (subxyphoid)
Protip: For patients with AI you don't need the Glidewire or AL1. Use second pigtail to cross.
Medications on table:
- Lido/Bupivicaine 50/50
- Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
- 10 ml Rotaglide yellow syringe
Edwards:
- Crimper
- Indeflator
- Appropriate delivery system and valve
Standby ECMO & Pericardial Effusion supplies
Sentinel:
- Grandslam 300cm
- 5/6 Slender
- 2.5 Verapamil
- DSA at 6fps of aortic arch with contralateral pigtail
- Don't open sentinel until we see the Grandslam advanced to the arch
- Prep instructions in lab 1 on the wall next to the light switches
For coronary protection:
- Radial access OR 12F dryseal in LFA if using sentinel
- 6F JL4
- Runthrough
- coronary balloon on md request
- 22G Grey Lido needle for Spies
Procedure
SEE BELOW FOR STEPS SPECIFIC TO SPIES and AGRAWAL
- Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE.
- Leg strap secured above knees. Wrists restrained.
- Patient prepped from naval to mid thigh using chlorahexidine soap followed by chloraprep with 3 minute dry time.
- Towel off site. Extend Femoral drape all the way to chin.
- Extension tubing for anesthesia flushed and secured on respecitve sides of the groin .
FRONT TABLE
- 50/50 Lido and Bupivacaine mix used for local anesthetic. Have extra available on front table.
- 1-1.5 L of Hep Saline in large bowl
- 10ml of Rotaglide on table (Attached to E sheath)
- 10ml syringe of Epi on table.
- U/S guidance for groin access
BACK TABLE- valve prep
- 3 Bowls: (1) Normal Saline (500ml in each bowl) (1) Hep Saline (500ml) (1) 30ml contrast (170ml Hep Saline added to by scrub person to make it 15%)
- 20 ml of contrast in cup (100% contrast available on table. May need for hand injection or for peripheral balloon prep)
- 60ml Syringe with contrast mixture for balloon prep.
- 20ml Syringe for flushing delivery system
- Indeflator: volume dependent upon valve size
- Crimper
- High pressure stopcock
PROCEDURE STEPS
- Contralateral arterial access - 6fr. Sheath (normally LFA) using micropuncture. Verify wire position with fluoro and save an image.
- Primary access - with micropuncture. Verify wire position with fluoro and save an image
- Pre-close x 1, sutures secured with hemostat.
- 8F sheath reconstituted and advanced after pre-closure.
- Pigtail -> LFA -> AO root injection
- Standard Injector settings 10/10 20mm valve, 15/15 23mm and 26mm valve, 20/20 29mm valve
- AL1 advanced through 8F sheath over standard J.
- Standard J removed and crossing wire advanced. Cross valve. Wire removed.
- Measure EDP and gradient.
- 8F sheath removed and E Sheath advanced.
- Insert valve delivery system
- Test pacer, black alligator clip on back of wire.
- Pacing : Unipolar Pacing - pace 120 - 180 , V max output 20ma. "Dial up to 180, dial down to 120, per MD request"
- Pacing : Bipolar pacing - pace 160 with 220 burst , A max output 25ma, set RAP to 220.
- Multiple AO grams for positioning
- Pace -> AO gram -> Pigtail pulled back -> Deploy valve
- Cine length set at 40 seconds or more
- TTE
if post dilation is needed...
Rep will come up and re-prep valve, adding desired amount of additional volume
If Safari was pulled back, recross wire will be needed (260cm angled stiff glide)
- Pigtail readvanced to AO for AO gram (15/30 standard injection)
- Safari exchanged for 260 J
- Delivery system removed
- Have second perclose, tools and dilator ready
- Protamine given, Preclosures completed, manual pressure for 5ish minutes
- Pigtail pulled back to iliac bifurcation and subtracted iliac angio performed (6/18 on Acist)
- Pigtail removed
- Secondary access Perclose
- Exofin all access sites, no dressing needed.
THE SPIES TAVR EXPERIENCE
Equipment:
- 5Fr Micropunture Kit
- 6Fr x 10cm sheath
- 8Fr x 10 cm sheath
- 8Fr x 35 cm Brite Tip Sheath
- (2) Cordis 150J
- Cordis 260J
- 2 Perclose
- 2 Pigtails
- Straight steel .035 wire (NO straight stiff glide)
- Amplatz ES for sheath advancement
- Safari
- 5F Abbott Pacel Balloon Flow Directed Tip Pacing catheter for CS
- Dual Red/Black Pacing Remington cables
- EP Quad Cable
Procedural Differences
- E Sheath in right after pre-closure over Supracore
- AL1 advanced with J wire backloaded.
- After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced.
- Safari advanced through pigtail and pigtail removed.
- Iliac angio 6/18ml
- Lido with EPI at end of case
THE GROVES TAVI EXPERIENCE
Product Substitute
- 2 pigtails
- Amplatz ES 1CM tip
- Balloon-tipped Abbott Pacer
AGRAWAL SPECIAL
- All accesses with mircopuncture
- 2 Percloses on primary access site
- .035 Standard Straight wire for valve crossing
- After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced. Amplatz ES advanced through pigtail and pigtail removed.
- Amplatz ES to exchange 8F for E sheath
PERIPHERAL BAILOUT EQUIPMENT
- Have everything available in the room, but verify items prior to opening.
- 5F Rim Catheter
- 6F or 7F Destination RDC
- Exchange length Glidewire advantage
- Exchange length angled glidewire
- Supracore wire
- Mustang balloons on 75cm shaft (6mm to 10mm x 40mm)
- Viabahn stents
Approved: MM/YY